# DEPTFORD FAMILY DENTAL PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528207198
- **Authorized official:** EDWARD POLLER DDS (PRESIDENT)
- **Authorized official phone:** (732) 914-1039

## Contact information

- **Practice address:** 2000 CLEMENTS BRIDGE RD, SUITE 117 A, DEPTFORD, NJ 08096-2011
- **Practice address phone:** (856) 848-6006
- **Practice address fax:** (856) 848-6969
- **Mailing address:** 2000 CLEMENTS BRIDGE RD, SUITE 117 A, DEPTFORD, NJ 08096-2011
- **Mailing address phone:** (856) 848-6006
- **Mailing address fax:** (856) 848-6969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI017432 | NJ | Yes |

## Other

- **Enumeration date:** 02/05/2009
- **Last updated:** 02/05/2009